利多卡因高钾温血停搏液对犬心肌保护的实验研究

The experimental study of lidocaine hyperkalemia warm blood cardioplegia on myocardial protection of dog

目的观察利多卡因高钾温血心停搏液(LHKWBCP)对犬心肌的保护效果。方法12只杂种犬随机分为对照组、利多卡因组(n=6)。常规建立体外循环(CPB),对照组用ST-ThomasⅡ冷晶体心停搏液常规灌注,首次剂量20ml/kg,每隔30min复灌一次,量为10ml/kg,共4次。利多卡因组用LHKWBCP,仅灌注一次(5ml/kg)。心脏停搏120min,辅助30min,停机后30min结束实验。监测围手术期血流动力学指标、血清中肌酸激酶(CPK)、心肌钙蛋白T(cTnT)及心肌三磷酸腺苷(ATP)的含量;并取左心尖心肌组织作电镜检查,称量心室肌干湿比。结果围手术期血流动力学各项指标、血清CPK、cTnT含量、心肌ATP含量、心肌干湿比组间比较差异无统计学意义(P>0.05);电镜检查两组心肌细胞结构无差异,肌纤维无水肿,线粒体、细胞核完整。结论LHKWBCP对犬心肌结构和功能有良好的保护作用。LHKWBCP具有配制简单,使用方便,所需量少,维持心脏电机械活动静止时间长的特点,具有临床推广使用价值。

Objective To observe the protective effect of lidocaine hyperkalemia warm blood cardioplegia （LHKWBCP） on the construction and function of dog myocardium. Methods 12 mongrel dogs were randomly divided into two groups, control group and lidocaine group（n=6）. Cardiopulmonary bypass （CPB） was routinely established. Cold crystalloid ST-Thomas Ⅱ cardioplegia was perfusedroutinely in control group. Single-dose LHKWBCP was injected in lidocaine group （5 ml/kg）. Heart was arrested for two hours, CPB assisted circulation for half an hour after releasing aortic crossclamp. Experiments were over after 30 minutes of postoperation.The changes of electrocardia and hemodynamics , the serum levels of CPK,cTnT were observed perioperatively. The ATP content of myocardial tissue was measured. Myocardial tissue of left ventricular tip was observed with electronic-microscope, Dry-wear ratio of myocardial tissue was measured. Results The changes of hemodynamic parameters, the serum levels of CPK and cTnT,the ATP content of myocardial tissue and dry-wear ratio of tissue weren＇t satistically significant between two groups. There weren＇t different in myocardial cell ultrostructure between two groups. Conclusion LHKWBCP showed the better protective effect on construction and function of myocardium . LHKWBCP is a simple, convinent and practical cardioplegia and has some practical value in clinic.